Articles

Venous involvement in neurological disorders and aging

The extracranial venous system is complex and variable between individuals. Until recently, these variations were acknowledged as developmental variants and were not considered pathological findings. However, in the last decade, the presence and severity of uni- or bi-lateral jugular venous reflux have been linked to several central nervous system (CNS) disorders such as transient global amnesia, transient monocular blindness, cough headache, primary exertional headache and most recently to Alzheimer's disease. The most recent introduction of a composite criteria-based vascular condition named chronic cerebrospinal venous insufficiency (CCSVI) that was originally linked to multiple sclerosis increased the interest in better understanding of the role of the extracranial venous system in the pathophysiology of CNS disorders. The ultimate cause-consequence relationship between these conditions and CNS disorders has not been firmly established and further research is needed.

This article collection in BMC Medicine and BMC Neurology aims to synthesize the current concepts and most recent findings concerning the evaluation, etiology, pathophysiology and clinical relevance of the potential involvement of the extracranial venous system in the pathology of multiple CNS disorders and in aging.

All articles in this cross-journal collection have been independently prepared by the authors and have been subject to the standard peer-review processes of the journals.

Robert Zivadinov and Chih-Ping Chung discuss the role of extracranial venous abnormalities in central nervous system (CNS) disorders and aging, and caution that treating these abnormalities should be avoided until clinical trials show beneficial outcomes.

Robert Zivadinov, Guest Editor of the article collection 'Venous involvement in neurological disorders and aging' discusses the potential role of the extracranial venous system in the pathology of multiple central nervous system (CNS) disorders and aging.

Venous dysfunction is associated with several inflammatory central nervous system (CNS) diseases; J S Alexander et al. review the pathophysiology of these conditions, and suggest that exploration of the venous system could open new therapeutic windows.

Presence and severity of chronic cerebrospinal venous insufficiency (CCSVI) in multiple sclerosis (MS) patients, assessed by extra-cranial and trans-cranial doppler sonography, is not associated with cognitive decline and depression in these patients.

There is currently no standard imaging modality used for detecting extra-cranial venous anomalies; Robert Zivadinov and colleagues review the diagnostic imaging techniques in clinical development, concluding that a multimodal approach is necessary.

Neurological disorders, such as multiple sclerosis (MS) and leukoaraiosis have been associated with venous abnormalities that contribute to the pathophysiology; Clive Beggs reviews the evidence for this, concluding that the role of cerebral flow in MS remains unclear.